Table 1

Documentation best practices, barriers and additional questions

Purpose of indicationBarriersBest practicesFuture questions
Improve antibiotic prescribing during order entry (eg, nudging, decision support or mindful moment).
  • Alert fatigue.

  • Uncertainty of diagnosis.

  • Need for efficiency.

  • Gaming.

  • Incongruent with decision-making process.

  • Early end-user engagement during design and testing.

  • Incorporate into existing workflows.

  • Frame in terms of improved patient care.

  • Make doing the ‘right’ thing easy.

How to streamline documentation (ie, reduce the need for multiple places/layers of documentation)?
Can mindful moments be triggered in other ways (eg, during note writing, checklists, timeouts)?
Allow prospective audit and feedback.
  • Resistance to feedback.

  • Highly clinician dependent.

  • Resource intense.

  • Use existing documentation rather than requiring additional documentation.

  • Frame in terms of improved patient care.

How can hospitals with fewer resources successfully conduct prospective audit and feedback?
  • Redundancy of documentation.

  • Multiple modalities for documentation (paper, EHR).

  • Multiple systems preventing closed loop communication.

  • Need to protect patient privacy.

  • Mandatory indication on prescriptions.

  • Patient instructions with clear antibiotic indication and directions.

  • Frame as a safety issue.

How to harness technology to communicate across settings without imposing threats to patient privacy?
  • EHR, electronic health record.